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You are watching: The lateral malleolus is found on the distal end of what bone

StatPearls . Treacertain Island also (FL): StatPearls Publishing; 2021 Jan-.


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Anatomy, Bony Pelvis and Lower Limb, Fibula

Marco Gupton; Akul Munjal; Michael Kang.

Author Information

Introduction

The fibula is a lengthy bone in the reduced extremity that is positioned on the lateral side of the tibia. The fibula is a lot smaller and thinner than the tibia. It is situated just behind the tibial head at the knee joint and then runs down the lateral aspect of the leg till it reaches the ankle joint. A ridge on the medial surconfront of the fibula forms the interosseous border wbelow the fibula is connected to the tibia using the interosseous membrane. This connection creates a syndesmotic joint, interpretation it has very little bit mobility.<1><2><3>

The framework of the fibula can be broken down right into the head, neck, shaft, and distal finish of the fibula. As the head becomes narrow distally, the fibular neck is developed. The fibular shaft lies distal to the neck and also has actually three surdeals with, lateral, medial, and also posterior. The form of the fibular shaft is established by the muscle attachments. Originally, it is a triangular shape and distally becomes more irregularly shaped. The distal end of the fibula creates the lateral malleolus which articulates through the lateral talus, creating component of the lateral ankle. The posterior and also lateral tibia kind the posterior and also medial malleolus, respectively. 

Like the tibia, the fibula is ossified in 3 locations, in the middle and at either end of the epiphysis. Ossification of the fibula begins in the shaft at roughly the eighth week of gestation and also then extends to either end. The procedure of ossification is finish by the second decade of life. Both ends of the fibula reprimary cartilaginous.


Structure and also Function

Unchoose the tibia, the fibula is not a weight-bearing bone. Its main feature is to incorporate with the tibia and also carry out stcapability to the ankle joint. The distal finish of the fibula has actually a number of grooves for ligament attachments which then stabilize and carry out leverage during the ankle movements. The lateral (fibular) collateral ligament attaches to the lateral side of the fibular head. This ligament offers knee stability. However, the fibula itself has actually a tiny role in offering knee stcapability.


Blood Supply and Lymphatics

The blood supply to the fibula is from the fibular artery (also known as the peroneal artery) which has many type of tiny branches which supply the diaphysis. The epiphysis and the proximal fibular head are offered by branches of the anterior tibial artery. The periosteum also receives plenty of small branches from the fibular artery and also provides the remainder of the bone. It is vital to know the blood supply of the fibula bereason this bone is often provided as a graft for rebuilding of the mandible.


Nerves

The fibula"s lateral surconfront, deep fascia, and also intermuscular septum form the borders of the reduced limbs lateral compartment. Within this compartment runs the superficial fibular nerve, which is responsible for plantar flexion and eversion. The fibula"s posterior surface, deep fascia, and also interosseous membrane develop the borders of the reduced limbs posterior compartment. The tibial nerve runs with this compartment and also is responsible for plantar and digit flexion. The fibula"s medial surchallenge partly borders the reduced limbs anterior compartment.


Muscles

Many kind of vital muscles affix to the fibula which molds the fibular shaft into its unique form.


The biceps femoris tendon attaches to the fibular head.
The fibularis longus and fibularis brevis tendons connect to the lateral fibula.
The extensor digitorum longus and extensor hallucis longus tendons attach to the medial fibula.

Surgical Considerations

Fibula bone grafts are the gold conventional in mandibular reconstructive surgeries. This is bereason removing the fibula from its anatomical place will not greatly influence weight bearing, as that is mainly the attribute of the tibia. In addition, the fibula is thin and also lengthy while maintaining great vascularity. This enables for basic graft uptake and also osseointegration of dental implants. When using the fibula as a graft, just the shaft is used, and also two ends of the fibula are left intact.<3>


Clinical Significance

Congenitally

Tright here is strong support in current literary works to use the fibular shaft length to estimate infant bone age. This may be a more accurate alternate to the present approaches of counting ossification centers or viewing hand/wrist or knee radiographs as suggests of estimating infant bone age.

Fibular hemimelia or fibular hypoplasia-aplasia is the a lot of frequent lengthy bone deficiency. This reasons partial or finish lack of the fibula. This is normally diagnosed at birth as soon as limb-size discrepancy and also lack of digits are listed. In addition, the lack of a lateral malleolus destabilizes the mortise in valgus. Hence, ankle fusion is generally needed.

Neurologically

The proximal finish of the fibula has a slightly enlarged prominence which contains a facet that articulates through the lateral condyle of the tibia. Just lateral and also posterior to the fibular neck runs the prevalent fibular nerve (additionally recognized as the widespread peroneal nerve), which might end up being entrapped after trauma, straight injury or in the time of its course near the fibular head. Typical fibular nerve entrapment is the the majority of widespread entrapment neuropathy of the reduced extremity. Symptoms may include foot drop and lateral limb sensory deficits, yet offered the absence of clear symptoms, misdiagnosis is common and also may cause a hold-up in treatment.

Fractures

The fibula can develop an avulsion fracture when tbelow is a sudden contractivity of the biceps femoris muscle. This results in a far-ranging pull on the fibula bereason the biceps femoris tendon attaches to the fibular head.

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The distal fibula proceeds to end up being the lateral malleolus. The lateral malleolus is substantially even more obvious than the medial malleolus and also deserve to be palpated at the ankle. On the lateral facet of the ankle, the distal fibula is additionally vulnerable to fracture (typically spiral), that deserve to occur during forced external rotation of the ankle. Anvarious other indicates of injury occurs in the time of evariation of the foot (exterior twisting of the foot) or straight trauma. The resulting fracture from an evariation injury is usually a transverse fracture of the fibula. A clinical decision-making tool dubbed The Ottawa Ankle Rules (OAR) have the right to be offered in suspected lateral malleolus injuries. The OAR is beneficial in lessening unvital radiographs and are a trustworthy tool to exclude fractures in children over age 5.

Fibular fractures alone rarely cause compartment syndrome. However before, once a tibial plateau fracture is present, tright here is a higher likelihood that the fibular fracture will certainly contribute to the compartment syndrome.    <4>